| NPI | 1609337245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS024689) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 62750) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-08-05 |