| NPI | 1922173814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 21476) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 21476) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: KY 21476) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2021-07-13 |