| NPI | 1225080682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2003026494) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS 04032538) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-07-16 |