| NPI | 1518451970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR DO207327) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-05524) |
| 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: WI 75561-21) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2024-07-05 |