| NPI | 1558479402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD455716) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC AL27458) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2017-11-09 |