| NPI | 1568625127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202849) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R1660) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2012-10-15 |