| NPI | 1689265621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01086321A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD472568) |
| Enumeration Date | 2021-02-02 |
| Last Update Date | 2021-08-17 |