| NPI | 1033591383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT209735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD465266) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2018-12-12 |