| NPI | 1073908034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 27820) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 27820) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2025-05-12 |