| NPI | 1235316712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD 00048196) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 059823) |
| Enumeration Date | 2008-01-27 |
| Last Update Date | 2021-05-24 |