| NPI | 1285716522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 38475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01059128A) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2008-10-27 |