| NPI | 1932193182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD459612) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60602814) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2016-12-16 |