| NPI | 1659421790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD436574) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT184703) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2011-11-28 |