| NPI | 1710921242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 20199) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 20199) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2017-01-09 |