| NPI | 1609215078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 49495) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125062742) |
| 207R00000X Internal Medicine (Licence: KY TP237) | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2016-09-16 |