| NPI | 1386056422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: GA 1031577657) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2017-01778) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2023-01-11 |