| NPI | 1659534238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD444821) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA mt192010) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2016-03-31 |