| NPI | 1932266590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD428115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 53239-20) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2010-04-19 |