| NPI | 1801872874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 18772) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 15976) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2007-07-08 |