| NPI | 1215970769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD046529L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 155421) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-07-27 |