| NPI | 1659664415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD451653) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199250) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2014-05-15 |