| NPI | 1760975403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MT215742) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125074766) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2019-07-02 |