| NPI | 1225254949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 19434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01045524B) |
| 207R00000X Internal Medicine (Licence: KY 33914) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |