| NPI | 1114335049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43267) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 40576) |
| 207R00000X Internal Medicine (Licence: MI 4301067795) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2015-01-23 |