| NPI | 1396154381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID O-1196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0475A) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2022-03-15 |