| NPI | 1861696346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301087291) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 43419) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2023-11-27 |