| NPI | 1295792455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD046207L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD-046207L) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2011-04-19 |