| NPI | 1700827714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 49116) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 17206) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2021-10-25 |