| NPI | 1205122280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD453660) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200576) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2015-06-17 |