| NPI | 1104936798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS5574) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL OS5574) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL OS5574) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS5574) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-04-23 |