| NPI | 1821288937 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME89947) | 
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME89947) | 
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME89947) | |
| 207QB0002X Family Medicine, Bariatric Medicine (Licence: FL ME89947) | |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL ME89947) | |
| Enumeration Date | 2007-07-26 | 
| Last Update Date | 2012-07-11 |