| NPI | 1871926246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV #ED0399A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 0000003971) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2023-12-22 |