| NPI | 1114333911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: AZ 54462) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 54462) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-06-05 |