| NPI | 1992775977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: PA MD444355) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX H0905) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2021-03-31 |