| NPI | 1770108417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD488276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101273830) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2025-05-27 |