| NPI | 1396971370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME150972) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD445187) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2022-11-15 |