NPI | 1568954501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: KY 05279) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02005749A) |
207Q00000X Family Medicine (Licence: KY 05279) | |
Enumeration Date | 2018-06-05 |
Last Update Date | 2022-08-31 |