| NPI | 1245729870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 34079) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OR MD203727) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2025-08-11 |