| NPI | 1346207891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-00706) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD043754E) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2016-08-08 |