| NPI | 1174812366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD453616) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 052881) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2015-07-21 |