| NPI | 1386830776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MD D0068121) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH2893) |
| 183500000X Pharmacist (Licence: MD 11998) | |
| 207Q00000X Family Medicine (Licence: DC MD036361) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D0068121) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: DC MD036361) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2017-03-08 |