| NPI | 1457333262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD-021137E) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD021137E) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2015-07-06 |