| NPI | 1861650681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511558) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD438854) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2024-09-03 |