| NPI | 1538466073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD015556e) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: PA MD015556e) |
| 207U00000X Nuclear Medicine (Licence: PA MD015556e) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2011-02-18 |