| NPI | 1558382754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME103529) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 12627) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 2009-01363) | |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2013-06-05 |