| NPI | 1720309297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: PA OS016761) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: PA OT013448) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2016-06-15 |