| NPI | 1427258946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43942) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 24249) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2021-05-12 |