| NPI | 1003943416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM MD2015-0638) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 26393) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 26393) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2015-10-27 |