| NPI | 1417245515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301098432) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: WA MD60565072) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2016-12-27 |