| NPI | 1174730667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI MD-16186) |
| Additional Taxonomies | 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: PA MT184223) |
| 207Q00000X Family Medicine (Licence: DC MD039012) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2021-06-02 |