| NPI | 1144211541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 29702) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 29702) |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2015-04-09 |