| NPI | 1194085902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01077390A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 48216) |
| Enumeration Date | 2012-05-26 |
| Last Update Date | 2020-09-09 |