| NPI | 1306225388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD471680) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 294290) |
| Enumeration Date | 2015-05-25 |
| Last Update Date | 2021-12-02 |