| NPI | 1831187582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD034265E) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 034265E) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2021-03-16 |