| NPI | 1760664767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0009391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT187966) |
| 207Q00000X Family Medicine (Licence: DE C1-0009391) | |
| 207R00000X Internal Medicine (Licence: PA MD437693) | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2022-06-27 |