| NPI | 1730609306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: GA 89137) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 89137) |
| 207Q00000X Family Medicine (Licence: SC LL41021) | |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-06-21 |