| NPI | 1225149859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101252858) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA A92152) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: DC MD040643) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2006-01320) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D0081318) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-05-09 |