| NPI | 1770012932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: MO 2021026473) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021026473) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2025-04-10 |