| NPI | 1699939223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-6393) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY IP1080) |
| Enumeration Date | 2008-07-13 |
| Last Update Date | 2011-08-12 |