| NPI | 1184734410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 10602) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 4914) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 10602) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AK 4914) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2012-02-02 |