| NPI | 1104164011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD040066E) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD040066E) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2013-01-28 |