| NPI | 1912974171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 37028) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 37028) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2017-08-18 |