| NPI | 1457352643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 32329) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 11681) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2016-03-10 |