| NPI | 1902053234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301102710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD443705) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2015-07-29 |