| NPI | 1689690216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 029513) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 029513) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CT 029513) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-06-10 |