| NPI | 1699759142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MA 73860) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MA 73860) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2012-12-10 |