| NPI | 1043504871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD451445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200040) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2014-04-18 |