| NPI | 1518018738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 30528) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 058836) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2018-06-11 |