| NPI | 1528621893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD488658C) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC CS221201029) |
| 207R00000X Internal Medicine (Licence: NY 319275) | |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2025-10-21 |