| NPI | 1528668720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AZ 65267) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 35191R) |
| 207Q00000X Family Medicine (Licence: FL ME154019) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME154019) | |
| 207Q00000X Family Medicine (Licence: AZ 65267) | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-08-07 |