| NPI | 1205039757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 16664) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 292251-1) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: DC MD048978) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2022-06-30 |