| NPI | 1659934776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD489907) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2022034377) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2025-06-04 |