| NPI | 1609491786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS022784) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019782) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2023-05-20 |