| NPI | 1518948017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL 053693) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 4202) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 127795) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2010-07-15 |