| NPI | 1356759286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NH 18256) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0444A) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2024-07-30 |