| NPI | 1679571756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD0288E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 028828E) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-03-30 |