| NPI | 1710900113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA OS005685L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA OS005685L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2008-09-25 |