| NPI | 1649563784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD451078) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199430) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2018-04-04 |