| NPI | 1174646202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 16527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 16527) |
| 208D00000X General Practice (Licence: PR 16527) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2024-09-18 |