| NPI | 1467453274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: IA 44229) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD22881) |
| 207Q00000X Family Medicine (Licence: ID M-7760) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2019-02-20 |