| NPI | 1568500700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: ID M5398) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID M5398) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-02-26 |