| NPI | 1487961918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD449621) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT197710) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2025-09-29 |