| NPI | 1619295540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 46843) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R2429) |
| 208000000X Pediatrics (Licence: KY 46843) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2022-05-26 |