| NPI | 1790018125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0500X Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine (Licence: PA MD053983L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD053983L) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: PA MD053983L) | |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2013-01-10 |