| NPI | 1164699666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 50845-020) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WI 50845-020) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2020-09-14 |