| NPI | 1689762338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL me0044573) |
| Additional Taxonomies | 207QA0000X Family Medicine, Adolescent Medicine (Licence: FL me44573) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL me004573) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-05-17 |