| NPI | 1982337010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD487546) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT225428) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2026-04-11 |