| NPI | 1073562674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 22948) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 22948) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2017-01-06 |