| NPI | 1124019252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: WI 67151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301056424) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2017-05-16 |