| NPI | 1699938498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 21500) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT192586) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2014-09-15 |