| NPI | 1023384781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2022-00180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49253) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2022-05-16 |