| NPI | 1861951857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD481953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 34715) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-04-15 |