| NPI | 1619051026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: CT 57200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 234789) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2017-12-07 |