| NPI | 1619137064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CA 20A 11771) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11771) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2021-11-29 |