| NPI | 1093036329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX r1630) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 66967) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036132737) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-10-12 |