| NPI | 1609435486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD479959) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA FK5266071) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-08-12 |