| NPI | 1093725624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 28198) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 30074) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2011-10-17 |