| NPI | 1194731323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 901805591205) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: UT 180559-1205) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-06-25 |