| NPI | 1518901990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 23276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200001325) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2016-08-01 |