| NPI | 1720270838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 43465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2013-01852) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2023-11-13 |