| NPI | 1962484592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: OR MD24391) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD24391) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WA MD60191672) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2023-10-09 |