| NPI | 1952836140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: GA 99721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 227248) |
| 2085R0001X (Licence: NC 2022-01714) | |
| 2085R0001X (Licence: PA MT215447) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2024-05-15 |