| NPI | 1962853135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 008120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT017279) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2025-01-20 |