| NPI | 1265482574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 33446) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 33446) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2015-05-11 |