| NPI | 1902118383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD440514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101247862) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2017-04-27 |