| NPI | 1205121423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 04212) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS12700) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2018-04-26 |