| NPI | 1780952994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 47337) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 34272) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2018-07-25 |