| NPI | 1396304739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD478466) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA HS000009L) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2022-12-08 |