| NPI | 1114120839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 054868) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 171089) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 054868) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2016-07-15 |