| NPI | 1366718579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: MT 49898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 49898) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2021-05-19 |