| NPI | 1346374113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD459009) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL 28236) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2020-08-31 |