| NPI | 1003896408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NM 2013-0110) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22501) |
| 207Q00000X Family Medicine (Licence: CO 44207) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2023-04-05 |