| NPI | 1104829142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 32185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 32185) |
| 208600000X Surgery (Licence: NC 32185) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2020-10-08 |