| NPI | 1578852265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NM MD2022-0981) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 8197) |
| 207Q00000X Family Medicine (Licence: WA MD60391126) | |
| 207Q00000X Family Medicine (Licence: NM MD2022-0981) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2023-10-19 |