| NPI | 1639550064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD464238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT208870) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2018-10-18 |