| NPI | 1326046731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 18374) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA 18374) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: IA 18374) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2009-09-02 |