| NPI | 1902475619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD486169) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT223601) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2024-07-31 |