| NPI | 1548320070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101055640) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101055640) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2013-03-06 |