| NPI | 1811068323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301097497) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 49941-020) |
| 207Q00000X Family Medicine (Licence: MI 4301097497) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2014-05-23 |