| NPI | 1669435772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME126725) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD067664L) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2016-06-23 |