| NPI | 1780666461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101007588) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101007588) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2011-12-13 |