| NPI | 1851570899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: VA 0102035626) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0102035626) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0102035626) | |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2025-04-09 |