| NPI | 1659936474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD479478) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 251410) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2024-01-09 |