| NPI | 1700842879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 057997) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD024539F) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-12-01 |