| NPI | 1831200187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 029085) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 029085) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CT 029085) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-03-22 |