| NPI | 1255494332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101035672) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D0035281) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101035672) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2026-05-28 |