| NPI | 1518588342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 60922) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA R-12452) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2025-07-16 |