| NPI | 1861809741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 27620) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT206229) |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2021-05-24 |