| NPI | 1104141761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 32750) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY IP1161) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2026-06-12 |