| NPI | 1912969833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME41509) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: FL ME41509) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2010-07-01 |