| NPI | 1215218771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 2619) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0106B) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2022-04-21 |