| NPI | 1063742740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME115832) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 28394-r) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME115832) | |
| Enumeration Date | 2010-01-02 |
| Last Update Date | 2019-05-13 |