| NPI | 1609987528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 51183) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200401444) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-09-23 |