| NPI | 1174904544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2018010293) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MO 2018010293) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-06-07 |