| NPI | 1366452807 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.13101R) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: LA MD.13101R) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-09-12 |