| NPI | 1235111931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 32145) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 32145) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2016-09-19 |