| NPI | 1689637258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD456500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME51370) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2018-12-03 |