| NPI | 1750768875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP609) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0102204751) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2022-02-16 |