| NPI | 1790901999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 22552) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD440261) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2018-06-28 |