| NPI | 1902132871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS015421) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT012423) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2012-09-11 |