| NPI | 1063600310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME83577) |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: FL ME83577) |
| 207QS1201X Family Medicine Sleep Medicine (Licence: FL ME83577) | |
| 207QA0401X Family Medicine Addiction Medicine (Licence: FL ME83577) | |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: FL ME83577) | |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2013-01-23 |