| NPI | 1235634098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 55210) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY r4813) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2022-10-31 |