| NPI | 1629046834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 31620) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 31620) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-12-09 |