| NPI | 1477996213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME121382) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME121382) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2020-06-22 |