| NPI | 1407952443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 34987) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01060120A) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2014-07-08 |