| NPI | 1104856475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 2325) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: AZ 2325) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-04-13 |