| NPI | 1396005310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WI 63698-20) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD459066) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2020-06-03 |