| NPI | 1659662831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD14608) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R2619) |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2014-05-13 |