| NPI | 1720306244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: HI 22790) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME0154142) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OR MD155819) | |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2025-08-04 |