| NPI | 1225065063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101008985) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101008985) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: MI 5101008985) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2020-11-17 |