| NPI | 1932496239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-29734) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200496) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2023-12-20 |