| NPI | 1649773219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 04791) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY R4938) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2025-07-03 |