| NPI | 1235373994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT 194213) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2012-01443) |
| Enumeration Date | 2009-04-26 |
| Last Update Date | 2025-08-13 |