NPI | 1245259902 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D61199) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: MD D61199) |
Enumeration Date | 2006-07-19 |
Last Update Date | 2011-12-21 |