| NPI | 1477579241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101265782) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 34534) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2018-12-31 |