| NPI | 1649216896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NM 86-141) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM CS00009180) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2014-01-24 |