| NPI | 1790797058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: DC MD25551) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00010849) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NE 21545) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2007-07-08 |