| NPI | 1568408748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD027094E) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: PA MD027094E) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2012-10-19 |