NPI | 1518451970 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WI 75561-21) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA DO-05524) |
Enumeration Date | 2018-06-19 |
Last Update Date | 2021-07-03 |