| NPI | 1083678650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 64053) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KS 04-32664) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS MD 12748) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-09-02 |