| NPI | 1609078286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106081) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD434575) |
| 207R00000X Internal Medicine (Licence: CT 045467) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2025-04-30 |