| NPI | 1598959918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467642) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101257660) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2019-07-16 |