| NPI | 1073052387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD470483) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT212372) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2020-08-18 |