| NPI | 1346254950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 19957) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD065624L) |
| 207R00000X Internal Medicine (Licence: OH 35077922) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2019-03-11 |