| NPI | 1952445058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42545) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY r1105) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2021-01-12 |