| NPI | 1063852168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA 14678) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101020768) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2021-12-06 |