| NPI | 1891745386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 35436) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: KY 35436) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2021-02-16 |