| NPI | 1518375567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP721) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY tp721) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2018-06-15 |