| NPI | 1548573405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD453538) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 24128) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2021-04-15 |