| NPI | 1659871150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214767) |
| Enumeration Date | 2018-02-20 |
| Last Update Date | 2025-01-27 |