| NPI | 1336466200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME155981) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: LA MD206346) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: FL ME155981) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2023-03-30 |