| NPI | 1710235221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD452529) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA C186007) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2024-05-04 |