| NPI | 1831808963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD042808E) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD042808E) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2022-11-17 |