| NPI | 1124102124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD042473E) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: PA MD042473E) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |