| NPI | 1902052160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD445909) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: DC 134734) |
| 207R00000X Internal Medicine (Licence: DC MD037603) | |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2014-08-05 |