| NPI | 1407812159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0047799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD056210L) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-03-29 |