| NPI | 1922412378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018857) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116027206) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2018-12-10 |