| NPI | 1750608121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 69933-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD448299) |
| Enumeration Date | 2010-04-26 |
| Last Update Date | 2018-09-26 |