| NPI | 1770946568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: HI MD-22093-0) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2019-01372) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2025-09-02 |