| NPI | 1043277122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NY 284883) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: DC MD035057) |
| 207Q00000X Family Medicine (Licence: MD D0057579) | |
| 207Q00000X Family Medicine (Licence: VA 1010236585) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WI 54742) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2020-09-30 |