| NPI | 1538517313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467358) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03722) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2019-06-14 |