| NPI | 1366523110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 9278) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AL 9278) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: AL 9278) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2013-04-01 |