| NPI | 1619264280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-00901) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 30732) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2021-09-16 |