| NPI | 1073731949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CT 55041) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 159888) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NY 159888) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-10-11 |