| NPI | 1609258201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT209544) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX T5442) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-11-05 |