| NPI | 1871151100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD474501) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NH 38063) |
| Enumeration Date | 2019-06-01 |
| Last Update Date | 2025-10-02 |