| NPI | 1265614366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD440135) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt190901) |
| Enumeration Date | 2007-11-29 |
| Last Update Date | 2010-10-20 |