| NPI | 1538456843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: GA 87480) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 87480) |
| 207Q00000X Family Medicine (Licence: MS T2453) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 87480) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MT205630) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TN 53095) | |
| 2081H0002X Physical Medicine & Rehabilitation, Hospice and Palliative Medicine (Licence: VA 0101260415) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2021-02-23 |