| NPI | 1104895374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 062771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 22570) |
| 207R00000X Internal Medicine (Licence: MA 264368) | |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: MA 264368) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2022-02-03 |