| NPI | 1871511055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02004075A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02002984A) |
| 207R00000X Internal Medicine (Licence: KY 03023) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-03-29 |