| NPI | 1609540145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 76948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223445) |
| Enumeration Date | 2021-08-08 |
| Last Update Date | 2024-06-12 |