| NPI | 1124468384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD458954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A156853) |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-11-10 |