| NPI | 1174985345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301504101) |
| Additional Taxonomies | 207PH0002X Emergency Medicine, Hospice and Palliative Medicine (Licence: MI 4301504101) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301504010) | |
| Enumeration Date | 2016-03-25 |
| Last Update Date | 2024-07-22 |