| NPI | 1083804041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0102201993) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2013-07-10 |