| NPI | 1720572340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MI 4301505128) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301115526) |
| 207Q00000X Family Medicine (Licence: MI 4351031013) | |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2023-05-18 |