| NPI | 1407071558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 24697) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: NC 24697) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 24697) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2018-07-30 |