| NPI | 1487708145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 18537) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: AL 18537) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2022-02-22 |