| NPI | 1740697317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD472461) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 37942) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2025-05-14 |