| NPI | 1598764011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 113446) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 113446) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2026-06-12 |