Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD-418340
PA
207RP1001X
Pulmonary Disease Physician
Primary
MD-418340
PA
207RS0010X
Sports Medicine (Internal Medicine) Physician
MD-418340
PA
Other
Enumeration date
—
Last updated
—
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