| NPI | 1790064871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD443427) |
| Additional Taxonomies | 207RH0003X Internal Medicine Hematology & Oncology (Licence: PA MD443427) |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: PA MD443427) | |
| Enumeration Date | 2011-08-08 |
| Last Update Date | 2012-01-22 |