| NPI | 1508097015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202658) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116021762) |
| 207P00000X Emergency Medicine (Licence: VA 0102202658) | |
| 207R00000X Internal Medicine (Licence: KY 03406) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2012-09-20 |