| NPI | 1154306462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: CT 027003) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 027003) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2007-07-17 |