| NPI | 1124288865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42211) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 42211) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2012-07-18 |