| NPI | 1588087068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 7041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49192) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2017-02-06 |