| NPI | 1336450659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03550) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116022865) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2013-06-12 |