| NPI | 1144331521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 023754) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: CT 023754) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-01-22 |