| NPI | 1891089082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD450738) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248155) |
| Enumeration Date | 2011-06-05 |
| Last Update Date | 2014-04-10 |