| NPI | 1093992653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME116072) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: GA 63057) |
| 207Q00000X Family Medicine (Licence: NV 13553) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2020-12-07 |