| NPI | 1669449187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 34090) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 29834) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-07-21 |