| NPI | 1619132800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NV DO2549) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NY 264391) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 264391) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: CT 53240) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2024-02-20 |