| NPI | 1508247925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H0088743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OS018453) |
| 207R00000X Internal Medicine (Licence: PA OT016755) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-09-24 |