| NPI | 1124002043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 12758) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WV 12758) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-09-25 |