| NPI | 1609849272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 01010343661) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101034661) |
| 207Q00000X Family Medicine (Licence: VA 0101034661) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2009-11-25 |