| NPI | 1790721918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 35629) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 35629) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2018-09-11 |