| NPI | 1811991219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NC 32605) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 32605) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2013-01-08 |