| NPI | 1033506191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 29445) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 32890) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2023-11-07 |