| NPI | 1912435413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD472009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213680) |
| Enumeration Date | 2017-05-27 |
| Last Update Date | 2020-10-08 |