| NPI | 1952697047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H88284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS017019) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2019-10-17 |