| NPI | 1285013037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD491288) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A155927) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2025-07-25 |