| NPI | 1962500702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 110024) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MO 110024) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-12-14 |