| NPI | 1780972935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: KS 04-39079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098934) |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: KY 47515) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2016-08-01 |