| NPI | 1679524284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301050164) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301050164) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2011-07-07 |