| NPI | 1912123886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS10160) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: GA 056817) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-07-30 |