| NPI | 1700873312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD070363L) |
| Additional Taxonomies | 207RA0401X Internal Medicine Addiction Medicine (Licence: PA MD070363L) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2016-09-13 |