| NPI | 1700260437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MD h91777) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 04100) |
| 207Q00000X Family Medicine (Licence: VA 0102205377) | |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2024-04-18 |