| NPI | 1508247925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT016755) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2019-08-13 |