| NPI | 1770143018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD476753) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT218409) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2024-04-03 |