| NPI | 1730753971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS023196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT020731) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2024-04-16 |