| NPI | 1861870412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 51927) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME157147) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2022-08-16 |