| NPI | 1255374716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NV 12030) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R3H65) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2007-09-12 |