| NPI | 1780267005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS023424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT020645) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2024-06-21 |