| NPI | 1962761080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0079210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD452099) |
| 207R00000X Internal Medicine (Licence: PA MT201116) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2015-09-22 |