| NPI | 1831417799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME115357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R2481) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2013-07-31 |