| NPI | 1669032421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 35075) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 56328) |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-10-09 |