| NPI | 1124205935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42126) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125050349) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2018-03-12 |