| NPI | 1801357926 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD479180) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD479180) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-11-27 |