| NPI | 1548899172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: GA 100706) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 100706) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2025-11-13 |