| NPI | 1114973567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA OS005724L) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS005724L) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2021-07-19 |