| NPI | 1184660243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 14843) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 16311) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 31968) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2007-07-11 |