| NPI | 1366470148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 20938) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD429954) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-10-18 |