| NPI | 1245498997 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NC 2012-01287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-8323) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: SC 61290) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2025-02-06 |