| NPI | 1215223698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 52954) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0075028) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2024-05-21 |