| NPI | 1922389568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD453072) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125060618) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2023-10-27 |