| NPI | 1558404343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 39604) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 39604) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2020-12-09 |