| NPI | 1710563408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS023853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 010305) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2024-07-17 |