| NPI | 1760485080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine (Licence: NC 200300007) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 200300007) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2025-08-06 |