| NPI | 1043292691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO R2A78) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL DO-82) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AL DO-82) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2012-06-15 |