| NPI | 1376788117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 49589) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R1758) |
| 207R00000X Internal Medicine (Licence: KY 44204) | |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2024-04-11 |