| NPI | 1558785022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY C1813) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 24341) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2023-12-28 |