| NPI | 1710939558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 39087) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 39087) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-04-20 |