| NPI | 1306837091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD06091L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD06091L) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2009-11-23 |