| NPI | 1114211422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KY 04544) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 04544) |
| 207Q00000X Family Medicine (Licence: IL 125.059121) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2020-11-16 |