| NPI | 1932264868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 30373) |
| Additional Taxonomies | 208D00000X General Practice (Licence: KY 30373) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2023-03-15 |