| NPI | 1679776645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD439596) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT190941) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2014-12-16 |