| NPI | 1790891182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME0046419) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0046419) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME0046419) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2013-10-01 |