| NPI | 1467717819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME122932) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT202721) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2021-03-22 |