| NPI | 1417268657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD453170) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 45894) |
| 207R00000X Internal Medicine (Licence: MD D79763) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-12-14 |