| NPI | 1417949173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD039913-L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD039913L) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2011-09-01 |