| NPI | 1669586442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TN 66396) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2007-01061) |
| 207Q00000X Family Medicine (Licence: OR MD167386) | |
| 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: OR MD167386) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2023-05-19 |