| NPI | 1861506891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0068037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0068037) |
| 207R00000X Internal Medicine (Licence: PA MD034193L) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2020-08-26 |