| NPI | 1821053851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01045680A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 30488) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2019-03-20 |