| NPI | 1679513477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME31637) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME31637) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2016-03-08 |