| NPI | 1174783310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 33801) |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine (Licence: SC 33801) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2020-12-21 |