| NPI | 1508900994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD437484) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 228738) |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2011-11-21 |