| NPI | 1790993988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD434573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA Mt187155) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2013-04-16 |