| NPI | 1194919159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 40695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 1066082A) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2020-02-13 |