| NPI | 1598327678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2022024916) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2019023481) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2022-06-30 |