| NPI | 1265875843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018146) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT015148) |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2017-03-06 |