| NPI | 1275518425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NC 2013-02005) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME89498) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2015-07-15 |