| NPI | 1710303383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL me131319) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT205435) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2018-08-09 |