| NPI | 1124332200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP479) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI L1812714) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2013-11-19 |