| NPI | 1609188945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS016416) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT013485) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2020-12-10 |