| NPI | 1942861836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT217415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DE C1-0026251) |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2023-07-31 |