| NPI | 1487845467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR E-4192) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2001019982) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-06-14 |