| NPI | 1134482276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2012016527) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2020-12-04 |