NPI | 1255777397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 5101020457) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH BM9528324C166) |
Enumeration Date | 2013-05-15 |
Last Update Date | 2021-02-24 |