| NPI | 1659336212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO R8J68) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO R8J68) |
| 207Q00000X Family Medicine (Licence: KS 04-36500) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2019-09-19 |