NPI | 1598965352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 064154) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 002483) |
Enumeration Date | 2007-07-20 |
Last Update Date | 2014-07-15 |