| NPI | 1831300532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME95059) |
| Additional Taxonomies | 111NR0400X (Licence: PA AJ002516L) |
| 207R00000X Internal Medicine (Licence: NC 2008 00631) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: PA DC-002516-L) | |
| 207R00000X Internal Medicine (Licence: PA MD072508L) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2024-08-29 |