| NPI | 1790796316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M0092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP516) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2017-03-07 |