| NPI | 1700439056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D93469) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT217746) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-06-16 |