| NPI | 1295182731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 55956) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME139375) |
| Enumeration Date | 2016-05-14 |
| Last Update Date | 2023-08-09 |