| NPI | 1710935267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME97967) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP339) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2019-12-09 |