| NPI | 1457701831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474758) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT210708) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2021-08-11 |