| NPI | 1396700647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01034928A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 23401) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2021-01-20 |