| NPI | 1659669901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME120866) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT200415) |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2014-09-25 |