| NPI | 1114377850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467896) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2016016982) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2020-04-13 |