| NPI | 1740326800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101007880) |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: MI 5101007880) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-07-15 |