| NPI | 1417018045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 11491) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NV 11491) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NV 11491) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2009-03-18 |