| NPI | 1881736403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine (Licence: PA OS004043L) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: PA OS004043L) |
| 207R00000X Internal Medicine (Licence: PA OS004043L) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |