| NPI | 1164419578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: FL 120760) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: WI 42141-20) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: CA G69425) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-05-18 |