| NPI | 1316130321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: HI 4804) |
| Additional Taxonomies | 2080H0002X Pediatrics Hospice and Palliative Medicine (Licence: CA A104571) |
| 207RH0002X Internal Medicine Hospice and Palliative Medicine (Licence: CA A104571) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2010-05-01 |