NPI | 1255310249 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WV 1567) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1567) |
Enumeration Date | 2006-01-10 |
Last Update Date | 2016-01-28 |