| NPI | 1053043471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 50573) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT225690) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2025-06-09 |