| NPI | 1740849710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA os021864) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT019258) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2022-07-05 |