| NPI | 1215933726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 21509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 21509) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2015-06-22 |