| NPI | 1205275104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD458829) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT205133) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2020-11-04 |