| NPI | 1588942320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME119508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199013) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2014-09-10 |