| NPI | 1619111804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 24628) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 134) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2024-03-18 |