| NPI | 1063497584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS005422L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA 05005422L) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2022-12-30 |