| NPI | 1649210683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD040086E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA md-1696803) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-03-02 |