| NPI | 1750346094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 20940) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 20940) |
| 207P00000X Emergency Medicine (Licence: WV 20940) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2009-03-23 |