| NPI | 1235511932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT209561) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 66832) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2024-02-27 |