| NPI | 1346532108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OR MD188756) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: LA md.207522) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 390200000) | |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2018-08-09 |