| NPI | 1124022546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME61377) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0061377) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2021-06-07 |