| NPI | 1447210711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 33542) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 33542) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-03-17 |