| NPI | 1215387824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NC 2022-02705) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02705) |
| 207Q00000X Family Medicine (Licence: NY 304771) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2022-11-04 |