| NPI | 1104076645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MS 20408) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 242928) |
| Enumeration Date | 2008-09-20 |
| Last Update Date | 2012-02-10 |