| NPI | 1891385753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 59586) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 86272) |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2024-06-27 |