| NPI | 1922062827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 33222) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01046412A) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2021-09-13 |