| NPI | 1528366457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 46899) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT198566) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2019-05-01 |