| NPI | 1942520465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME124856) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD012577E) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2017-11-17 |