| NPI | 1881055820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS019152) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016920) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2020-12-10 |