| NPI | 1609868942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD051413L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 038133) |
| 207R00000X Internal Medicine (Licence: FL ME104749) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2021-01-23 |