| NPI | 1477562767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 942704071205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 2704071205) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: UT 972704071205) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2016-07-27 |