| NPI | 1861492720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 24565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 038979) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 038979) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2026-02-12 |