| NPI | 1376779124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD445417) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT195627) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2014-10-22 |