| NPI | 1134233919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 65274) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 50177) |
| 207Q00000X Family Medicine (Licence: KS 04-32219) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CO 50177) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KS 04-32219) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-05-26 |