| NPI | 1720591555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: VA 0101278021) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA A176026) |
| 207Q00000X Family Medicine (Licence: CA A176026) | |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2023-07-14 |