| NPI | 1891996708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD039488L) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD039488L) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2016-01-06 |