| NPI | 1114912961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: AZ 24495) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 24495) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 24495) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 24495) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2020-08-12 |