| NPI | 1386721579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 252170) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME116369) |
| 207Q00000X Family Medicine (Licence: PA MD430130) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-01-16 |