| NPI | 1811095417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 4301042169) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME96644) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-04-25 |