| NPI | 1245238922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NH 14925) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301062135) |
| 261Q00000X Clinic/Center (Licence: CA A65580) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-08-01 |