| NPI | 1245239524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: AK 4287) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND 9941) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2023-03-07 |