| NPI | 1376806745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: UT 12229890-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A129202) |
| 208000000X Pediatrics (Licence: CA A129202) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2021-05-26 |