| NPI | 1912206111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA MD485287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD485287) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2024-07-09 |