| NPI | 1720046881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2000160622) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2000160622) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC 31239) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2024-04-10 |