| NPI | 1417480260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD485898) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 86460) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2024-07-08 |