| NPI | 1992727390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO 19454) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 19454) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: CO 19454) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2011-11-07 |