| NPI | 1619396868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: CT 72314) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CT 72314) |
| 207Q00000X Family Medicine (Licence: DC MD045554) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-11-08 |