| NPI | 1124291448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CT 048604) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD432931) |
| 207Q00000X Family Medicine (Licence: CT 048604) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2015-08-19 |