NPI | 1063508463 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ Az #12127) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN Mn#24356) |
207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ Az #12127) | |
207QG0300X Family Medicine, Geriatric Medicine (Licence: MN Mn#24356) | |
Enumeration Date | 2006-10-04 |
Last Update Date | 2011-07-26 |