| NPI | 1396724050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 09677R) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: LA 09677R) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2010-08-03 |