| NPI | 1174207427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NE 36514) |
| Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: NE 36514) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2026-07-01 |