| NPI | 1033273164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M11308) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT183942) |
| 207R00000X Internal Medicine (Licence: MD D0066240) | |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2012-01-04 |