| NPI | 1649361502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD046251L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 16834) |
| 207R00000X Internal Medicine (Licence: OH 35.063311) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-07-28 |