| NPI | 1568652048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL 101122) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT187382) |
| 207R00000X Internal Medicine (Licence: FL trn10774) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2013-11-06 |