| NPI | 1245219567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2014-01006) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 26270) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2014-01006) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2016-12-08 |