| NPI | 1932367646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT191305) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD440423) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2010-08-26 |