| NPI | 1497082895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0116022013) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP386) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2016-10-28 |