| NPI | 1720272859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME112570) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT189510) |
| 207R00000X Internal Medicine (Licence: IA 38260) | |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2020-06-02 |