| NPI | 1588991772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD460202) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 267651) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2020-08-26 |