| NPI | 1760942569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 57157) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 93473) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2022-12-01 |