| NPI | 1598298226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 55764) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP290) |
| 208000000X Pediatrics (Licence: KY TP290) | |
| 207R00000X Internal Medicine (Licence: KY R4554) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2022-09-27 |