| NPI | 1891115945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD481351) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD481351) |
| 208000000X Pediatrics (Licence: TN 56026) | |
| 207R00000X Internal Medicine (Licence: TN 56026) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2023-07-29 |