| NPI | 1679683841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01042525A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD053889L) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |