| NPI | 1346669512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 276683) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA 463951) |
| 207R00000X Internal Medicine (Licence: CA 149352) | |
| 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: RI 16379) | |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-03-07 |