| NPI | 1457557001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 31220) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101056013) |
| 207R00000X Internal Medicine (Licence: TN 38942) | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2022-09-23 |