| NPI | 1902043771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME103393) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME103393) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME103393) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2020-08-20 |