| NPI | 1922011386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME41996) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2006005752) |
| 207P00000X Emergency Medicine (Licence: KY 44177) | |
| 207RC0000X Internal Medicine Cardiovascular Disease (Licence: KY TP628) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-12-21 |