| NPI | 1750597076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD040010L) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: PA MD040010L) |
| 209800000X Legal Medicine (Licence: PA MD040010L) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-09-12 |