| NPI | 1366508830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD432284) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD432284) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: PA MD432284) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2014-12-01 |