| NPI | 1285261875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD484705) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD484705) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2024-12-27 |