| NPI | 1003162637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TN 57972) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 270803) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD446356) | |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2018-10-22 |