| NPI | 1225066079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301036565) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301036565) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-08-31 |