| NPI | 1366718579 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: ME MD29646) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 49898) | 
| 207Q00000X Family Medicine (Licence: ME MD29646) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MT 49898) | |
| Enumeration Date | 2012-04-02 | 
| Last Update Date | 2025-09-02 |