| NPI | 1457849895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 30781) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV WV-SE-1773) |
| 207R00000X Internal Medicine (Licence: OH 57.246292) | |
| 207R00000X Internal Medicine (Licence: NC 2021-01078) | |
| 208D00000X General Practice (Licence: OH 57.246292) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-04-14 |