| NPI | 1487180519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT214093) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT214093) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-11-02 |