| NPI | 1922763549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 2586) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2586) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2021-12-21 |