| NPI | 1083627632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 26799) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 26799) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2017-11-21 |