| NPI | 1659689594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD457442) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 56424) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2022-09-21 |