| NPI | 1689053118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: ID M-13499) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID MRM-1473) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2025-04-15 |