| NPI | 1508855123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 28754) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 28754) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2022-07-21 |