| NPI | 1962821058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD466354) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV WV-SE-1762) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-02-16 |