| NPI | 1306097035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME125533) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036121223) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 3460) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2022-07-21 |