| NPI | 1376774059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME121252) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194577) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2025-08-01 |