| NPI | 1861978520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA 474628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214901) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2021-07-14 |