| NPI | 1376800409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 32929) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49153) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2024-02-01 |