| NPI | 1174872162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME125397) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-06-22 |