| NPI | 1861467581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200600580) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD426836) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2023-03-07 |