| NPI | 1225040157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AK 1707) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OR MD158400) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OR MD158400) | |
| 207R00000X Internal Medicine (Licence: OR MD158400) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2021-03-24 |