| NPI | 1598702086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 2830) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: AZ 2830) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2011-02-07 |