| NPI | 1609459890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA H000288L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD486019) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-07-17 |