| NPI | 1649254715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MA 234497) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: VA 0101-237793) |
| 207Q00000X Family Medicine (Licence: MA 234497) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2010-11-16 |