| NPI | 1639411176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD458168) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204372) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2016-09-02 |