| NPI | 1770749970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 03398) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125054879) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2020-10-27 |