NPI | 1255509873 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD436175) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NJ 25MA08756900) |
Enumeration Date | 2008-02-16 |
Last Update Date | 2018-01-08 |