| NPI | 1821626177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD486489) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101278734) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2024-10-10 |