| NPI | 1194749770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS003666L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS003666L) |
| 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA OS003666L) | |
| 207RG0100X Internal Medicine, Gastroenterology (Licence: PA OS003666L) | |
| 207RI0011X Internal Medicine, Interventional Cardiology (Licence: PA OS003666L) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-09 |