| NPI | 1366448508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD056054L) |
| Additional Taxonomies | 207RS0012X Internal Medicine Sleep Medicine (Licence: PA MD056054L) |
| 207RP1001X Internal Medicine Pulmonary Disease (Licence: PA MD056054L) | |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA MD056054L) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2009-10-16 |