| NPI | 1578635355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME98795) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD430232) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-12-11 |