| NPI | 1548345952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 15815) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: AZ 15815) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-03-22 |