| NPI | 1750875167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD475863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT215063) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-01-05 |