NPI | 1225080682 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2003026494) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KS 04032538) |
Enumeration Date | 2006-05-16 |
Last Update Date | 2014-07-16 |