| NPI | 1992320683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT019891) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS022867) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2024-05-21 |