| NPI | 1881044600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD467687) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD467687) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-08-15 |