| NPI | 1730703810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 58051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4351046827) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2023-06-18 |