| NPI | 1548242886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD061937L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD 061937L) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2023-02-02 |