| NPI | 1720293970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: PA MD438586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 187709) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2013-06-06 |