| NPI | 1568493328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 40264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP627) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2020-03-24 |