| NPI | 1326206897 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 068243)  | 
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IL 036-117456)  | 
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AL 29408)  | |
| Enumeration Date | 2008-05-30 | 
| Last Update Date | 2025-04-17 |