| NPI | 1760447247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 35010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01059452A) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-07-26 |