| NPI | 1528011301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 50996) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 30434) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2010-12-07 |