| NPI | 1700091881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-01231) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT185000) |
| 207R00000X Internal Medicine (Licence: VA 0101241714) | |
| 207R00000X Internal Medicine (Licence: WV 29246) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2021-04-30 |