| NPI | 1013136464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101241072) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WV 22758) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2023-09-18 |