| NPI | 1912014002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: CO 17709) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 17709) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2012-10-16 |