| NPI | 1235190018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 53316) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 12403) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-12-01 |