| NPI | 1811961899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MI 5101009705) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101009705) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2008-03-14 |