| NPI | 1063644326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 45488) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT196138) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2018-12-17 |