| NPI | 1942265053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 16982) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD014285E) |
| 208000000X Pediatrics (Licence: PA MD014285E) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-10-05 |