| NPI | 1972985604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D84517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209220) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-04-21 |