| NPI | 1003077702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101257837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 255361) |
| 207R00000X Internal Medicine (Licence: WV 23708) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-05-04 |