| NPI | 1073539847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37572) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01058945A) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2023-06-01 |