| NPI | 1689804031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD059254L) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD059254L) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2020-02-24 |