| NPI | 1750764601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP247) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 263876) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2021-07-20 |