| NPI | 1952630105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106002) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD438726) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2019-08-26 |