| NPI | 1831624097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020554) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT017592) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2023-01-05 |