| NPI | 1629033402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37458) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 37458) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2017-02-03 |