| NPI | 1558355438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 22657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 22657) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-10-19 |