| NPI | 1962713776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD186670) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2013-0214) |
| 207R00000X Internal Medicine (Licence: PA MT196663) | |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2021-02-05 |