| NPI | 1215222765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 300355) |
| Additional Taxonomies | 2086H0002X Surgery, Hospice and Palliative Medicine (Licence: LA 300355) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-08-19 |