| NPI | 1104011386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 59641) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 31574) |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: WI 59641) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2025-08-26 |