| NPI | 1285694711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60914768) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX E8431) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2019-02-11 |