| NPI | 1629364484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD451345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198879) |
| 207R00000X Internal Medicine (Licence: MN 64475) | |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2023-11-02 |