NPI | 1164400461 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MD D0037142) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101055024) |
Enumeration Date | 2006-01-06 |
Last Update Date | 2020-07-31 |