| NPI | 1912993387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA MD-25341) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: IA MD-25341) |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine (Licence: IA MD-25341) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2022-08-29 |