NPI | 1265478929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA MD00016863) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00016863) |
Enumeration Date | 2006-06-21 |
Last Update Date | 2021-04-26 |