| NPI | 1659331502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M6333) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NY 224658) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 055701A) | |
| 207Q00000X Family Medicine (Licence: MA 217823) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2013-01-21 |