| NPI | 1023007267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS008905L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD H0053714) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2020-08-20 |