| NPI | 1619469772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS020415) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018390) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2024-04-30 |