| NPI | 1679689368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: WI 26420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 26420) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: WI 26420) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-05-14 |