| NPI | 1982743993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101247640) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: NM 2006-0308) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-01-15 |