NPI | 1124022546 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME61377) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0061377) |
Enumeration Date | 2005-06-13 |
Last Update Date | 2021-06-07 |