| NPI | 1922538727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301509449) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD473391) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2023-08-15 |