| NPI | 1497710594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A94145) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY TP351) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA A94145) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2012-12-28 |