| NPI | 1003834136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 201500226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 6467) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 348) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-07-13 |