| NPI | 1063508463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ Az #12127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN Mn#24356) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ Az #12127) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MN Mn#24356) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2011-07-26 |