NPI | 1366406027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA C187030) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2007-01941) |
207Q00000X Family Medicine (Licence: SC 32278) | |
207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CO 53023) | |
Enumeration Date | 2006-04-12 |
Last Update Date | 2024-01-22 |