| NPI | 1225478688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TN 54645) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2013022046) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2018-03-17 |