| NPI | 1932327533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN TN45416) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP660) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2010-07-21 |