| NPI | 1275829145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 56961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY Tp893) |
| 207R00000X Internal Medicine (Licence: TN 51754) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2022-07-09 |