| NPI | 1639122492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD034148E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 22946) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-04-13 |