| NPI | 1295173235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467395) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101256801) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-07-29 |