| NPI | 1558427377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD-039080-L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD-039080-L) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2023-07-12 |