| NPI | 1073654422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS8066) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS003289L) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-07-08 |