| NPI | 1700383056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD481859) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 62441) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-10-03 |