| NPI | 1245312917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301067122) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301067122) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2021-03-10 |