| NPI | 1962459156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121730) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD433531) |
| 207R00000X Internal Medicine (Licence: ND 9827) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-06-08 |