| NPI | 1679139844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 61041) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 69688) |
| 207R00000X Internal Medicine (Licence: MN 30911) | |
| 183500000X Pharmacist (Licence: KY 015939) | |
| 183500000X Pharmacist (Licence: TX 49366) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-08-04 |