| NPI | 1942720883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD198684) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT214187) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-03-24 |