| 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 |