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 |