| NPI | 1396961967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY 42023) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35.088666) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 01066757A) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-05-07 |