| NPI | 1548825417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 61049) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: KY R6293) |
| 208D00000X General Practice (Licence: KY R6293) | |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-07-01 |