| NPI | 1699774695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS006971L) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: PA OS006971L) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-08-27 |