| NPI | 1144212135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME0037479) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME0037479) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0037479) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2023-03-07 |