| NPI | 1609437219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OT019576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 009516) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2025-10-20 |