| NPI | 1215985114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: TN 34321) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301043859) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MI 4301043859) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-06-29 |