| NPI | 1134111909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: OR 15601) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD 15601) |
| 207Q00000X Family Medicine (Licence: ID M 5124) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2015-10-15 |