| NPI | 1508845116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME 29256) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL ME 29256) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME 29256) | |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2008-04-28 |