| NPI | 1518196187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03481) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 2483) |
| Enumeration Date | 2009-07-04 |
| Last Update Date | 2022-10-05 |