| NPI | 1568499804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 40574) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 2372981) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-05-15 |