| NPI | 1386081503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT204161) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: PA MD0457985) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: PA MD0457985) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2020-05-21 |