| NPI | 1346792215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP851) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0116019991) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2019-12-06 |