| NPI | 1245544998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 45940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 242879) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2018-05-15 |