| NPI | 1710118393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 51353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194224) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2014-10-15 |