| NPI | 1255991675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351045495) |
| Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: MI 4351045495) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2025-07-21 |