| NPI | 1477559367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 32354) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 32354) |
| 208000000X Pediatrics (Licence: KY 32354) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2023-10-23 |