| NPI | 1003290628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD465037) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT209805) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2021-01-09 |