NPI | 1669532065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME0030650) |
Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301032214) |
Enumeration Date | 2006-12-08 |
Last Update Date | 2015-05-07 |