| NPI | 1154850618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD469133) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT213791) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-08-14 |