| NPI | 1083685879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA os005951l) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS-005951-L) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2021-03-17 |