| NPI | 1346450970 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA c168949)  | 
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: DC MD041355)  | 
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2007025194)  | |
| Enumeration Date | 2007-05-23 | 
| Last Update Date | 2023-11-02 |