| NPI | 1942468152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD469384) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD AP22784397762) |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2021-06-29 |