| NPI | 1689676504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 33029) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 33029) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2021-03-04 |