| NPI | 1154499002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: ME 017302) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 017302) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-10-01 |