| NPI | 1417905332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 30537) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01048261A) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2019-10-07 |