| NPI | 1730520057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS017721) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 078059313) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2021-01-09 |