| NPI | 1063948040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT212960) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT213803) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2018-07-20 |