| NPI | 1891323564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MN 69582) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 30904) |
| 208000000X Pediatrics (Licence: MN 69582) | |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2024-06-18 |