| NPI | 1386758613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA 02075) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IA DO-2075) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2023-11-22 |