| NPI | 1457649543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: HI MD17719) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI MDR-6176) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2018-03-29 |