| NPI | 1598851271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS4394) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 814) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-11 |