| NPI | 1619299583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 020245) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 020245) |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2023-10-06 |