| NPI | 1245232693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO R9D75) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R9D75) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: MO R9D75) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2019-10-28 |