| NPI | 1053310631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 010135144) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101035144) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2022-07-21 |