| NPI | 1699789982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: KS 0534566) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 3579) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2011-05-25 |