| NPI | 1851478085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43687) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL29141) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-08-21 |