| NPI | 1700868452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MS 10063) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 10063) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2013-11-07 |