| NPI | 1619281862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD449502) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301096840) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2013-07-17 |