| NPI | 1760786370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 47820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 125461-1) |
| Enumeration Date | 2010-12-23 |
| Last Update Date | 2019-08-23 |