| NPI | 1083160253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.178386) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT211563) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2026-08-24 |