| NPI | 1760472617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 35022) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 35022) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-06-09 |