| NPI | 1215218474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV ED0225A) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2014-07-23 |