| NPI | 1881115251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 20633) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD471030) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2024-10-16 |