| NPI | 1790911683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD444820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CO CDRH.53833) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2026-06-05 |