| NPI | 1710073507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 74998) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ME 1305) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL OS9988) | |
| 207Q00000X Family Medicine (Licence: GA 74998) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-08-03 |