| NPI | 1457478117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43179) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MT188156) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-04-08 |