| NPI | 1023506268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PR 22204) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 22204) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2025-01-12 |