| NPI | 1912110594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42900) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 36091) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2016-08-18 |