| NPI | 1083289631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD483217) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT222613) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2025-07-16 |