| NPI | 1073585238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: MI 4301051555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 051555) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2015-10-23 |