| NPI | 1134534654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 66841) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD475404) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-08-09 |