| NPI | 1124010400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD426930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME90837) |
| 207R00000X Internal Medicine (Licence: MI 4301077930) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2021-08-16 |