| NPI | 1154602324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL OS14158) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS14158) |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2019-04-18 |