| NPI | 1285721290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD066980L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 60214) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: PA MD066980L) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |