| NPI | 1689314254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TN 69796) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MD94642) |
| 207Q00000X Family Medicine (Licence: VA 0101289695) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: VA 0101289695) | |
| 207Q00000X Family Medicine (Licence: TN 69796) | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2026-08-21 |