| NPI | 1548331499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2008-0177) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD039314E) |
| 207R00000X Internal Medicine (Licence: WA MD026365) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-02-21 |