| NPI | 1700211141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MS 24153) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 47117) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2020-07-09 |