| NPI | 1144460155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD440342) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT 190163) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2018-04-06 |