| NPI | 1326421249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT016693) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS018395) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2020-12-19 |