| NPI | 1518090901 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: SC 26046) | 
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 26046) | 
| Enumeration Date | 2007-03-14 | 
| Last Update Date | 2019-06-14 |