| NPI | 1053567644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 29331) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MO 2008020462) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2021-12-16 |