| NPI | 1770502825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 26348) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01047877A) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-04 |