| NPI | 1063463917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 32582) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 32582) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2011-03-31 |