| NPI | 1639142995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37472) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 37472) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |