| NPI | 1083639140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 23063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 23063) |
| 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: IA 23063) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-12-29 |