NPI | 1245453166 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M9860) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M9860) |
Enumeration Date | 2007-04-10 |
Last Update Date | 2015-07-06 |