| NPI | 1518961275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 9701245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 18850) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: NC 9701245) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2015-05-28 |