| NPI | 1396820668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: FL ME91689) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME91689) |
| 207QA0000X Family Medicine Adolescent Medicine (Licence: FL ME91689) | |
| 207QA0505X Family Medicine Adult Medicine (Licence: FL ME91689) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-10-27 |